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All APPLICABLE INFO MUST BE COM rED FOR APPLICATION TO BE ACCEPTED—
Date: Permit Number: r\12
qY ON
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR®P®SED 1'N.PROEM12—T LC?CAT10N:
Address:
Legal Description:,
Property Tax ID#: ./,r, . //1����- Lot No.
Site Plan'Name: Block No.
Project Name:
Setbacks Front Back: Right Side: - Left Side:
DETAJLED DESCRIPTION ®F WORK:
CONSTR!UCTI®, 1 -®RMATION:
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank —Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq: Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height: _
E NSR/LE�S�S�E: O'IN ,13-104 1T1 X!,R"
• •-.•tN4' r,,,:, Name:o
Addres7/���'l,1 'iif.� ���,o , Company Lam/,. �`�✓ ��
City, State Address: X59
Zip Code: Fax: City:,& State/,�_:Z
Phone No. Zip Code: Fax:
E-Mail: Phone No �,g-
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License e_9PC11Zz�/1__
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sl1iP'PLEMEN=@-@N,19REORN LIEN LAW IN ®RIWIATI®N:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee Contractor as Agent for Owner Signa re f Contracto cense Holder'
STATE OF FLORIDA � STATE OF FLORIDA
COUNTY OF �q�fAA, COUNTY OF
The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this 1, day of, 20 "1 by this�_day of n[`12, 201- by
(Name of person acknowledging) (Name of person acknowledging)
�A CRQ%n,�,, ,&,
(Sign ure of Notary Public-Sta a of Florida) (Signature of Notary Public-§tate of Florida)
Personally Knowno uc clAde t Personally Known uced_I.1 of a ' n
Type of Identification' + 9" Type of Identification "YP a . LASHAHNA'1NGRAM
LASHAHNNIN ! Yp t►g
1 f F i ,,r - Notar
Produced r �: ,Notar.Publfp,=Shtent rid:: Produced •�: yPublic;,stae'otFt fida,+
.•;-My Comm xplrea Drip 20„2me ,� .•;My Comm Expires Dric 20, o18.
�;, o.. Compg� N FF 177249 Commission No. '"e oma.,, UCom@��r+ Ff 1772{
a r, i� o�.
Commission No. p.• ,,
Bonded t rough National Notary Assn Bonded threuph NatonsNotsry Anan, s
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014